COVID-19 testing and the Pacific border – Expert Reaction

With no active COVID-19 cases in New Zealand, the next frontier is our borders.

While the concept of a ‘trans-Tasman bubble’ with Australia was floated first, the Cook Islands has since suggested starting a safe travel zone with New Zealand.

The SMC asked experts to comment on what kind of testing may be required to open borders with Pacific nations. 

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“The COVID-19-free situation that New Zealand is now in is a tricky area for optimal surveillance system design – as it is such a novelty internationally. Testing everyone arriving at the border (as is planned to start soon) is probably a very good start as that will help assess the risk.

“If that risk is considered high then community surveillance will become more cost-effective – so that any border control failures can be caught early. One of the most promising forms of on-going surveillance is testing water in sewerage from whole cities for the SARS-CoV-2 virus – and ESR in NZ is exploring this.

“New Zealand should now be working hard to develop quarantine-free travel with Pacific Island nations that have been persistently COVID-19-free (e.g. Samoa, Tonga and Vanuatu). This might require NZ offering support to verify their COVID-19-free status with serosurveys (widespread antibody testing) or other verification processes. But these nations should be the first nations for NZ to work with for open travel arrangements – probably ahead of Australia which still has uncontrolled pandemic spread.

“Even Fiji – which has had a few cases long ago and none for many weeks, should probably now be considered COVID-19-free by NZ authorities. This would be win-win for both countries – New Zealanders can again holiday in Fiji, and Fijian workers can earn money in NZ.”

No conflict of interest.

Dr Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“Most of the Pacific islands remain COVID-19-free. Fiji and Papua New Guinea had cases and both are now free of the virus – although testing rates are lower, so we cannot be certain. One complication is that New Caledonia was COVID-free for nearly 30 days, but recently reported 2 new cases, in military personnel arriving from France.

“Samoa has requested testing of anyone travelling to Samoa but the local advice is that it is not necessary, and not helpful. The Cook Islands are opening their border to quarantine-free travel from NZ and no testing. So at this stage, there is no clear agreed policy as different jurisdictions have different policies.

“This is the reason why I am advocating a NZ/Pacific ‘bubble’ ahead of Australia. I know that politicians remain concerned having been through the measles outbreak in Samoa. It is important to note that the island nations are seeking the easing of restrictions in order to help their economies recover.

“I am confident that all of the island nations have good measures in place to restrict the importation of COVID-19.”

No conflict of interest declared.

Professor Ilan Noy, Chair in the Economics of Disasters and Climate Change, Victoria University of Wellington, comments:

“I definitely think we should open up for Pacific island travellers to come to New Zealand as long as they are not transiting from third countries, and to try and encourage our residents to travel to Pacific countries. We are not the sovereign in these countries; it is their decision whether they will allow New Zealanders in. It should be their decision whether they want to impose any testing requirements on travellers coming from New Zealand, but frankly I don’t think that is necessary, given our COVID-free status. If they do choose to require testing, we should assist in facilitating that, but it is their decision.

“I am fully aware of the troubling history, especially with the 1918-19 pandemic flu, but these are now sovereign countries.

“Again, we should not enable any transit through NZ to the Pacific Islands, unless we can guarantee the transiting travellers are COVID-free – which we cannot at the moment.

“Actually, I think there is some urgency in opening up; and am troubled that this sense of urgency is not manifest in a more rapid positive decision. Many in the Pacific depend very heavily on tourism, so the current slump is very significant for them, even though they have had no confirmed cases of the virus. Of course, all of this depends on us and the Pacific Island countries remaining COVID-free.”

No conflict of interest declared.

Dr Peter Saunders, Distinguished Scientist, Measurement Standards Laboratory of New Zealand, Callaghan Innovation, comments:

“Non-contact infrared thermometry systems (infrared thermometers and thermal imagers) are unlikely to be an effective border-control measure in detecting fever as an indicator of COVID-19.

“The first issue is related to calibration. All measurement systems must be calibrated against a standard that is traceable to the International System of Units to ensure reliable results that are repeatable from one instrument to the next and to assess the accuracy of the measurements. Infrared thermometry systems are particularly difficult to calibrate with sufficient accuracy to reliably detect fever because the results are sensitive to measurement distance and target size. In use, the temperature readings can appear either falsely high or falsely low if the conditions don’t match those during calibration. There are also a number of environmental factors that can further alter the readings.

“The second issue is that infrared thermometry systems measure skin temperature (usually the forehead), which must be used as a proxy for core body temperature in diagnosing fever. The relationship between skin temperature and core body temperature varies considerably from person to person and, for a given person, by levels of physical activity, exposure to nearby heat sources, and ambient temperature.

“The occurrence of false positives and false negatives using this technology is extremely high. As a screening tool, it may be useful to detect some cases of COVID-19, but most would slip through as false negatives. Any suspected case should always be verified by a qualified person using a clinical thermometer.”

No conflict of interest.